Aaron (00:17):
All right guys. Thank you for checking out this episode. I’m really excited today. I was able to get Casey Shifflet in for an interview. The topic that we’re going to discuss is burnout and ems. And I feel like this is a super important topic, especially considering the pandemic that we just got through. I was actually looking at an article this morning that was from 2019, just before the pandemic started in gems. And they were talking about like 60% burnout rates in ems. They pulled a whole bunch of paramedics and EMTs and about 60% of ’em considered themselves burned out. And even a higher percentage were considering leaving EMS from that burnout percentage. And I just thought that was super unfortunate and that was pre pandemic. So I mean, you can imagine how people feel now after what we just went through. A perspective change that I kind of had is I never feared getting whatever my patient was suffering from.
(01:11)
I never worried about having chest pain or a communicable disease for my patients. Whereas in the pandemic, you kind of lived in some fear that all the patients you’re transporting, you’re going to catch this virus that they have, bring it home to your family, give it to your grandparents, get sick of it yourself. And that was kind of a new thing I feel like for emergency medicine where we feared the people we’re taking care of to a degree. And now that we’ve emerged from that, I feel like burnout is still a very important topic to discuss and kind of figure out some tools to use to overcome it whether you’re on the ambulance or in the er. Burnout’s a huge topic right now and a lot of people are feeling very burned out. The article defines it with a couple of terms, exhaustion, decreased productivity, cynicism.
(01:59)
And again, those are all things that can lead to medical errors and poor patient outcomes. So I feel like it’s an important thing to figure out some tools and strategies to overcome burnout and actually enjoy your job and not just enjoy it, thrive in it. And I couldn’t think of anyone more qualified to talk about this and somebody that’s been in the field, I think longer than I’ve been alive and kind of figure out what’s in your brain, pick your brain and come up with some of these ways that you’ve thrived, at least from my perspective. You always have a great attitude when I see you and you’ve been doing this a very long time. And so I feel like people really stand to benefit from picking your brain and figuring out your perspectives. One disclaimer that I provide is that anything that we say is just our opinion. It doesn’t reflect who we work for now, who we’ve worked for in the past. It’s just our opinion only. So take it with just that in mind. Casey, if you wouldn’t mind just kind of giving me some of your background and how long you’ve been an ems, how long you were an emt, how long you’re a paramedic, that kind of stuff.
Casey (02:59):
Well before you said I’ve been doing this longer than you’ve been live. I was going to say this is what burnout looks like. I’m 22 and I’ve only been in the field for two years. So
Aaron (03:12):
Brand new out of EMT school.
Casey (03:14):
So I had hair and stuff before I started, but anyway, which is true, I actually did. So I believe I’m the longest practicing paramedic in El Paso County. Wow. Presently I’m from Pueblo, Colorado. I was born and raised there. I was a wildcat. I went to Central High School and I actually went to EMT school, actually, actually that’s not true. I didn’t go to EMT school. Cause back then you didn’t have to be an EMT to work on the ambulance. So I worked for my Glenn Grtk, who was one of my mentors and his passed away since just recently in the last couple of years. But anyway I worked for him. He owned a alert ambulance and you only had to have a ambulance license from the county, but you had to take a test to get it. And it was basically an EMT test.
(04:11)
And at 1718 I took that test and passed it and I worked on the ambulance and then I went into the Air Force. Once I was in the Air Force I became an EMT while I was there going to night school. And anytime that I was home on leave, I’d work on the ambulance and I felt better about the job because I was now an emt. Yeah. And I could say, but I first started working on the ambulance three days after my first child was born, which was August 10th, 1976. So August 10th this year was 46 years that I’ve been doing this. Wow. I’ve gone to paramedic school since I started and I went to paramedic school in 1979 and became a paramedic full-fledged cleared certified in March of 80. And so I’ve been a paramedic since March of
Aaron (05:04):
80. Gotcha.
Casey (05:06):
I worked in Pueblo from 76 until 83 in Pueblo. And then people like that I’d worked with down there like Nancy Rush and Jeff Young. Jeff Young convinced me to come up here. He said If you wanna hone your craft, Colorado Springs place to do it. And he wasn’t wrong. So I came up here to work with people like Randy Royal and Dave Mead and Rich Graff and I was able to work with those folks and did it honed me. And so Very cool. I’ve been doing that since
Aaron (05:38):
Think’s unique about Colorado Springs and El Paso County that a lot of other systems don’t have.
Casey (05:44):
Well initially, most of the people who who were working here went to the same school, most of ’em. There were only a couple of schools in Colorado back then and St. Anthony’s was one of them. And I went to school at St a’s. Okay. And graduated there. And we used to call it Holy Tony’s by the Sea cuz it was right by Sloans Lake. And I’m proud to say that I was one of Jerry’s kids Dr. Gerald Gordon. He’s essentially the person who brought paramedicine to Colorado. Yeah. Wow. Yep. Very cool. I think that had a little to do with it, that we had people, we had two ambulance companies, but almost everybody went to the same school and the overwhelming majority did anyway. And I think that we were, we’d done our ride time at Denver General and at the time, Denver General Denver Health and Hospital’s ambulance was probably one of the best places if you were a patient to ever encounter a paramedic. Oh, okay. Because your chances of making it outta the hospital alive was probably better than anywhere else in the world. So most of us went to school up there, went through their internships and stuff and I think just made us better medics and we were free to do a lot of that stuff. Our physician advisors at the time were pretty aggressive and progressive.
(07:17)
It’s just built since then. Just builds on
Aaron (07:19):
Builds. So really kind of some leadership initially. That was really what’s the word you used? Not proactive.
Casey (07:30):
Well it was progressive.
Aaron (07:31):
Progressive. Some very progressive leaders initially. Yeah, for sure. Very cool. Oh yeah. One thing I wanted to pick your brain about is the statement or the phrase that you say when you clear base, at least for the 10 years that I was full-time, I heard it probably hundreds of times. I don’t know if you still say it. Oh,
Casey (07:51):
Every day.
Aaron (07:52):
Hear it.
Casey (07:56):
Medic 12 for clear base, ready to save lives, alleviate pain and suffering wherever it is likely head. We do this because we really like people.
Aaron (08:06):
I love that. So why do you say that every day?
Casey (08:10):
Well partially cuz it’s true. That’s what we’re there for. We are there for it saving lives and alleviate pain and suffering and more so the further out in the career that I got, the more it was not the saving the lives part cuz that happens or it doesn’t. But the alleviating pain and suffering, we really can have a impact on people. And so that is true because I really like people. Part is sarcasm and how do we get through our days? We we’re sarcastic people as a general rule. And so we see so much tragedy and so much bad that sometimes we just have to be sarcastic and that’s how we get through.
Aaron (09:00):
Yeah, I love
Casey (09:01):
That. And I say it because I try to trip up the dispatcher on the other end of the radio and see how long it takes to answer me sometimes cuz they’re laughing but sometimes they don’t. Yeah.
Aaron (09:15):
From my perspective, hearing that even if I was having a rough day or not enjoying my job, I would hear you clear base and say that and talk about what you know, get into the field to do is to alleviate pain and suffering. Sometimes save lives if that opportunity happens and kind of sit up in my seat a little bit straight and be like, okay, this is what we’re here to do. This is the job. Get outta your head. This is what you’re here to do. And I like to think that a lot of people kind of felt that way when you clear base. So I think that has a huge impact. I appreciate that. I love that you still do that every day. I think that’s huge.
Casey (09:52):
Yeah. I’ve added a little to it. Sometimes I walk in the hospital and they’ll ask me how I’m doing and I’m telling ’em just here, glad to be part of the team and help in any possible way I can. Yeah, I got that from Mel Robinson who retired from Memorial, but he was one of my instructors in paramedic school by the way. Oh, awesome. But
Aaron (10:12):
Yeah, I think that’s such a powerful statement and super good perspective to have. One thing I want to talk about is burnout is not really something that happens because of your duration of time in ems, right? We see people that are six months out of the academy, they’ve been an EMT for six months, or a paramedic for six months. And you kind of see their attitude, their mentality, their bedside manner’s, terrible. They don’t care about their patients. They’re less likely to give pain meds to something that’s a really painful condition. Someone’s having a kidney stone and they let their EMT tech the call, they didn’t give pain medications. You see ’em in the hospital. They’re very cynical. They’re very arrogant a lot of times. And why do you think that is? Or what do you think it is that’s contributing to them feeling burned out that’s not related to their length of time in ems?
Casey (11:06):
Well, I think that we live in a 2022 is a much more cynical age than 1976. It just is as we’ve progressed and all the things that we’ve seen these last three years have been just awful on staff, on not just us, but police, fire emergency technicians in the er X-ray techs, lab techs nurses, PAs, nurse practitioners, doctors, all felt that pressure. And I, I’ve kind of seen that kind of cloud of cynicism over all those people. And so I think that just the sheer pressure of the last few years has added to that. But before that we had burnout as well. But I think that sometimes it’s kind of like teachers go to school to be teachers and they don’t get to teach until the very end and in most cases, and so they do their student teaching in the end and then go, man, I really don’t like kids.
(12:35)
So now they’ve wasted this four years to get a degree in teaching and now they get in it and find out that it wasn’t cracked up to be. And I think a lot of people get into EMS thinking, oh man, I’m going to drive with lights and siren. It’s going to be cool. I’m going to have an air of respect heaped upon me that they don’t necessarily have to earn. And they expect and I think that dealing with grandma 14 times in a month, that should probably be in a nursing home and continually falls or whatever. That doesn’t stretch your intellect really as far as the job goes. I said I think that has a bit to do with it. So plus the sheer increase in workload and that has a ton to do with it. And we’re expected to have more training. And I mean that’s all heaped on top of us.
(13:48)
Mm-hmm. Have your normal amount of training that you would do to for continuing ed to keep your certification. But as I do the companies that you work for, they insist on, you’re going to have to redo evoc, which is what we’re in the middle of right now at amr. Everybody that’s been driving for <laugh> forever now has to sit in a four hour class to, and I don’t have a problem with it. I think it’s a good thing keeps you fresh, but it also cuts into your family time for sure. And that kind of thing. So I think that those kind of pressures really lead to burnout. And some people just aren’t meant for this job. And I think they get stuck in it and just, it makes ’em toasty. And then they get, and with those increase in job in call volume pretty soon you start getting those calls that are really, really heinous kids. Burnt, broken, beaten, and you know, see some just really bad calls that really weigh on you. And when you add all that together, it tends to make you crispy.
Aaron (15:16):
Yeah. Yeah. I agree completely. That kind of leads a couple other things I wanted to talk about. I guess one is along the same lines, talking about those, not necessarily kids, but the amount of death that you do see on the ambulance as a PA in the er, I’m really not exposed to that. I was on the ambulance there was 1 48 hour shift I worked where I think I pronounced three different people and 48 hours. And having that discussion with family and determining whether you are the, and you don’t work ’em at all, or whether you do everything you can for a half hour to try to bring this person back and then having to have that discussion with the family. I would’ve considered myself burned out after that shift. I mean, three of those discussions is, it weighs on you really heavy. It’s a lot to take in. And they don’t teach you that in school. They don’t, I mean, how are you supposed to prepare for that? How are you supposed to prepare to have that conversation? And I guess if you, you’ve done that a million times and what would your advice be to somebody new to Paramedicine or even a new EMT in having that discussion? And I guess what mentalities do you have surrounding that?
Casey (16:42):
Well, first of all, I’d like to give kudos where kudos are warranted. In Colorado Springs. We do respond with Colorado Springs Fire Department and probably eight outta 10 times the lieutenant will handle that. Mm-hmm. Issue. They’ll handle that. Notifying the family that we’re, we’re going to stop our efforts and so on and so forth. But it’s not always the case. But those guys seem to be pretty good at it and gals actually. But I think one of the things that I’ve found is it is received better when you don’t sugarcoat stuff. Yeah. I’m sorry they’re gone. That doesn’t quite hit the mark. What do you mean they’re gone? Oh, did you take ’em to the hospital? Right. No, I didn’t take ’em to the hospital. But, well I’m also not crass, they’re celestial discharge. They’re assuming room temperature. No. So I think the thing that I would say is that you have to be direct, I’m sorry to tell you this, but your significant other whatever is, has died and there’s nothing more that can be done for them either here or at the hospital.
(18:22)
And we don’t tell them, oh, they’re in a better place cause we have no idea what their spirituality is. We have no idea what their beliefs are. We have no idea. And so I try to stay away from that. They’re in a better place. Well they’re suffering, no more suffering Now they can come to those, their own conclusions. So I think simpler is better and there’s always those inevitable questions of, okay, well where do we go from here? Well, do you have a family preacher or is there someone we can call for you? Or there family members that we need to call and get in touch with for you, which we offer. I always offer that. And so there, there’s that part of it. And also, again, going back to fire and pd, they’ve got a chaplaincy that’s available that they can have respond, which also helps a lot. So yeah, it’s probably one of the most difficult parts is dealing with the family. You can kind of distance yourself from the patient to themselves, but it’s hard to do that with the family and it tugs at your heart. Yeah, absolutely. Yeah.
Aaron (00:02):
One other thing too is kind of talking sympathy versus empathy. My understanding of sympathy is it’s kind of understanding from your perspective and empathy is more putting yourself in someone else’s shoes. Do you think that being too empathetic in emergency medicine is kind of an unhealthy perspective?
Casey (00:23):
That’s funny. I think of it the other way. Oh really? Yeah. I think of empathy as being more distant and understanding what they’re going through or trying to understand and that this is bad and you wouldn’t want it heaped on you. I feel sympathy is more like being part of that and I think being part of that issue. So this here’s a case. A lot of people that know me know that my son had cancer and passed away. So that was one of the hardest times in my life. Right? Absolutely. So when not too long after Nick died Shauna Hamner, who was one of our dispatchers she felt so bad because she realized that she was sending me on these hospice calls every day after I came back to work, and she felt really bad. So she sympathized with me. But what I told her is it made me feel better to be able to go in there and talk to these people and help them through that.
(01:47)
In that case, that was sympathy because I felt what they felt because I had lived through that issue. Whereas when grandpa’s had a heart attack and passed away in his sleep, and now I have to talk to grandma, now I’m empathetic because that’s not close to what I’ve lived. Sure. You know what I mean? So I think that probably empathy is better to have some distance, some distance, but in some cases there’s no getting around sympathy because you live that. And I had a call when I was younger when my son Nick was 18 months. He was very sick and he was in the hospital and I was a brand new paramedic and I had gone on a traffic accident in Pueblo and the kid that was involved in the accident was two, so pretty close to Nick’s age. Got cut in half in the accident, was still alive.
(03:03)
Had he been dead, I probably would’ve been a lot better with it, but I had to work on him. I had to transport him, and he rested on the way to the hospital. I got to the hospital and I’m this new paramedic, I’m a stud, so I’m doing CPR in this kid in the er, and I get lightheaded. I’m going to pass out. So I had to excuse myself, sit down, and I was like, this is bs. I can do this. I went back over there, same thing happened and I realized it really hit close to home. So that was sympathetic and I couldn’t imagine what that family was going through. And it almost ended my career actually. Wow. But my father-in-law, Glen, he told me those cases happened so rarely, and rather he was TriMed to get me to keep going. He said that patient had the best possible chance with you because of what and your skill and so on and so forth, which I appreciate it. But
Aaron (04:17):
Yeah. Yeah, I think that’s a really good story. I mean, sympathy will take its toll on you as a provider for sure. But I think it can make you a better provider in a lot of those instances where you can actually relate to someone’s situation. I have a similar one. My wife and I had a miscarriage a couple years ago, and that’s a conversation I have to have a lot in the ER is, Hey, you’re likely having a miscarriage. And a lot of times I will be sympathetic and how would I want the provider to tell me that? And I think about the way the provider approached it with us and said we were having a miscarriage and the attributes they expressed that I appreciated. And I try to sit down and actually take some time with the patient instead of just rushing in and out and sit down and answer the questions they have about it and sympathize with them.
(05:14)
Which certainly is harder on you emotionally to sit down and do that. But I think a lot of times patients do appreciate it if you’re coming from that perspective. But yeah, certainly over time and doing that too much I think can really take its toll on you. And absolutely at the end of the day, you wanna leave the job at the job so you can be there for your family. And that’s not always possible. So I think that’s important for people to kind of understand when they are being sympathetic versus when they’re being empathetic and kind of guard their minds a little bit. Like, Hey, I was really sympathetic on that call. I’ve been through a similar situation and because I expressed so much sympathy, you kind of need to be aware of what that does to you mentally and go home and form a healthy habit around that. We all know people that don’t have healthy habits surrounding EMS and they sympathize a lot at work and they go home and drink or have all these other unhealthy habits. I think just being aware of that when you’re doing it is super important. Or else it’ll definitely tear you down.
Casey (06:20):
Oh yeah. Eats you. Yeah. It eats you from the inside out. And if you sympathize too much, you can’t sympathize with every patient. And I’ve seen paramedics that have done that, and they’re not with us anymore. Either they’ve left found something else, thank God, or that they’ve met their demise in some way, shape matter or form drank themselves to get death pills whatever. And we’ve had some of that here in Colorado Springs and it’s awful. But yeah, it is what it is,
Aaron (07:01):
I guess. Yeah, I think that if you’re somebody that who can only sympathize and not distance yourself, it ends up being a detriment to you. And maybe this isn’t the field for you. If you’re sympathizing every time at a certain point with the vast majority of our patients, I think you need to see that they’re a patient, they’re not your family member in order to stay healthy for yourself and to be there for the next patient. True. But that’s a hard thing to do sometimes.
Casey (07:31):
It really is. And being a field training instructor and a teacher, I try to tell the students and my interns, I try to tell them that. They’ll ask me, how long you, you’ve been doing this so long, how have you been doing it? And I always tell ’em off the kind of cuff, well, it’s not my emergency and it’s not my emergency, their emergency. I’ve got other emergencies that I would never expect the plumber that I just picked up to help me with that emergency. What I mean that’s in my life. Unless it was obviously a plumbing emergency. But anyway, I just tell them. And sometimes they think that it’s harsh, but it’s the facts and it’s reality that if you want to do this job, do it well do it for a extended period of time. You have to adopt that kind of mentality where you can distance yourself from the patient in a way that you can take care of the patient and do those things without, with the least amount of discomfort for them and so on and so forth.
(08:47)
But yet, stay emotionally neutral as much as you can. And I think that that’s one of the things that they also, excuse me, don’t teach. I’ve along that same line too I remember sitting we’re doing more resilience type of training now after the fact in continuing ed and stuff. And I think I sit next to Matt Bergland one day in a paramedic refresher class. And it was one of the first classes that I can remember where we had somebody come in that talked about resiliency and how to maintain at this job. And Matt and I just kind of sat there and we were like, I don’t have that issue. I don’t have that issue. We were talking about P PTSD and so on and so forth. And we were like, I don’t have that. And so I took the opportunity afterwards to talk to the she was a psychologist.
(09:53)
I said, I’ve got a different issue. And Matt was standing there as well, and he agreed. I said, I feel bad that I don’t feel bad. And she said, oh, we get that too. So it’s just so multifaceted the issue. And I think we compartmentalize, Tracy and I were talking about this today earlier, that we tend to compartmentalize stuff. And I told her, I said, I think we do both put good bad, everything in compartments, different compartments, good or bad. And it’s kinda like a random access memory. We can pull from ’em if we need them or we can lock ’em away and keep ’em locked away. But I think that we tend to segment things off and put ’em away and
Aaron (10:51):
Yeah, I totally see that. I think, yeah. Cause I mean, you name any number of just horrible things that we’ve seen, especially doing this 46 years, you’ve seen everything. You name it, you’ve seen it. And I think back to the horrible tragedies that I’ve witnessed and the things that I’ve seen, and I’m kind of the same way. I don’t really feel like I have, you know, PTSD because of it, but I also, it’s kind of odd that I don’t feel mm-hmm worse about it. But I think that ability to compartmentalize, a lot of times people say that’s a bad thing, but that’s a necessity in ems. I mean, you can’t be thinking about your last patient when you’re running on your next one and still be a good provider. And none of us are perfect at that. And I think that’s an important thing. Going back to the sympathy versus empathy thing, I think it’s really good perspective from you that you have had calls where you’re sympathetic and you also realize that you can’t do that all the time.
(11:45)
And you’re not just empathetic, you’re not standoffish, you’re not viewing this just as a patient every time you’ve had had times where you’ve been sympathetic and you’ve had times when you’re empathetic. And I think just the awareness of that is super powerful for people to realize what they’re doing in the situation and not to be one or the other all the time. I think just knowing that about yourself is very powerful for people and explains why you can do this for so long. Just that awareness. I mean, cuz clearly you’re very aware when you’re in different modes and I feel like I am as well and I think that means you can do this for a while and still be healthy and as long as you’re not taking it out in the wrong ways or opening those compartments when you shouldn’t or open up a bottle of alcohol when you get home and opening that compartment, I think that’s
Casey (12:37):
Powerful. Yeah, I think you do need to open those compartments once in a while sometimes just to, for several reasons. Keep yourself humble. I think we get a godlike mentality. I, I’m doing this and I think that sometimes we need to be humbled and sometimes you need to open a box and go, man, I really screwed that call up and maybe I shouldn’t do that again. That kind of thing. But I think you do have to segment those things off and just keep ’em for whenever you need ’em.
Aaron (13:16):
Right. Yeah, I think that’s an important point. What you said is we don’t perform well on every call. We don’t, whether it’s a skill that you didn’t complete or a differential that you weren’t really considering when that was the problem. The whole time we run these calls that don’t go perfect, you’re like, I couldn’t get that innovation or whatever it is. And when it’s something like that, I think we can be really hard on ourselves and that goes into a compartment that call that I wish I had done better on. And that can eat at you too. I mean that’s another huge point that I wasn’t thinking about, but how do you get past that
Casey (13:54):
Stuff? Well, I see that stuff all the time with, cuz I’ve got students and I, I’ve got the blessing and the luxury of longevity and believe me, I’ve made every mistake. I’ve given the wrong meds, I’ve given the wrong dosages, I haven’t been able to get a tube when I should have been able to get that tube. I missed some, completely missed the assessment and go have an EM, brand new EMT go, well what do you think about this? Yeah, you maybe it’s that and go, yep, okay. You’re right. Think thanks for ing me up. But you know, do have that. And I have seen so many times when, for instance, when people are just learning how to do IVs, it’s such an important aspect of our job. There’s so much pressure about doing it. Yeah. Well, you know don’t get ’em all. You just don’t.
(14:52)
And I’ve seen people beat themselves up over and they get in slumps, <laugh>, start try 10 IVs and not get any of ’em and somebody will walk in and take the IV cat or throw it behind their back and get it and it’s like, so they get hard on themselves about that. So I’ll always ask ’em, okay, well let’s analyze this. Did you put the tourniquet on? Right? Yeah. Did you disinfect the area correctly? Yeah. Did you pick the proper vein? Yeah. How about the size of needle? Yeah. Okay. Did you use the correct angle of T with that? Yeah.
(15:35)
Did you get into the vein? Yeah. What happened? Well, the vein blew. Well, there’s no accounting for the cooperation of the patient’s vein. I said, you’ve done all your job right now. Now it’s up to the patient’s vein to do its job and sometimes it just doesn’t happen. And you’ve got 10 people in a row that you’ve not now not been able to do that on and they’ve not cooperated right now. And I, I’ll watch and I’ll say, Hey, maybe you should try this or do this. But if they’re doing it right, I have no suggestion for them. But just get on the horse and do it again. Yeah.
Aaron (16:09):
Stop thinking about all the ones you missed.
Casey (16:11):
Yeah, the next one’s, the next one. The next one. Yeah. So you know, see that and that leads to all
Aaron (16:17):
Sorts of issues. Yeah, I think that’s huge. I think that example of something as simple as an IV that you have to do a ton and not beating yourself up over that. Cause I think that is something you see newer people do is like, ah, I couldn’t get that iv. Whereas people that have been doing this a while, it’s like, well I didn’t get an iv. You some don’t, can only control so many of those variables. But I think moving on from that and not beating yourself up, I mean I think we can kind of extrapolate that to the higher level skills, the innovations, the medications that we have that are super dangerous if given it the wrong time, you can only control so many things. And if you have to at least learn from that last call, you can’t keep dwelling on it. You can’t keep beating yourself up or it’s going to impact your next patient. So you gotta learn from it, you gotta move on. And that’s really hard to do. And we’re dealing with life and death and our decisions have consequences. I mean, that’s a really hard skill to have to not beat yourself up over a call and move on. But I think that’s foundational to doing this job for any length of time is you have to move on from that last call
Casey (17:26):
For sure. And I, it happens so quickly and I can’t count the number of times I’ve gone shh and went, oh wait, I need to pull that back. And you can’t do it now, but you learn from it. It makes you better and you have to learn from it. If you don’t learn from it, then that’s where the issue is. Everybody makes mistakes. If you learn from ’em, then mistakes are great. So how we learn, yeah, it’s practice, right? It’s medical practice. It’s not medical. They say it’s art, but it is an art, but it’s a practice art.
Aaron (18:07):
Yeah. It’s not an exact
Casey (18:08):
Sign. No it’s not.
Aaron (18:09):
Yeah. It’s very much the practicing of medicine and they call it that for a reason. And if you don’t learn from your mistakes, I mean you gotta assign meaning. I heard somebody talk about all your past experiences. You have to assign meaning to that or else it’s nothing. And you’re, you’re going to stay in that horrible moment in your past until you’ve assigned meaning to it. And assigning meaning is learning from your mistakes and being able to move forward or else you’re
Casey (18:35):
Stuck there. It does. And it makes you timid and shy when your patient needs you to be bold and specific. And that’s what our patients need us to be. They need us to be able to make split second decisions. And I mean, in the field, we don’t have the luxury of pulling labs other than the sugar. We can’t tell what the lactate is. We can guess. We can’t tell what their pH is. We can guess because of other presentations. And we have to determine those particular things. And if you dwell on your mistakes, then you tend to pull back and not do the things that you were trained to do and that you know how to do and that you’ve done in the past. And it’s worked because if you let those things keep you back, it’s not good for you in the career and it’s not good for the patient, obviously.
Aaron (19:40):
Yeah. Yeah. That’s really good.
Casey (19:42):
Yep.
Aaron (00:01):
One thing I also read in that article, they had a quote from an ER doctor that was talking about burnout. It said burnout is the response of a normal person to a toxic environment. And actually kind of disagree with that. Yeah. Because I think how you respond to an environment is kind of on you. Yeah. I don’t think that we can’t control the scenes that you walk into. You can’t control the patient that you’re going to see. And so I feel like defining burnout as just a normal response to a toxic environment. We can’t control those environments. We can’t control the chaos on a scene. We can’t control the death on a scene. We can’t control that stuff. And so I feel like that’s kind of not a good perspective because if you have to control how you respond, we see people that respond to certain situations differently. And I feel like that’s blaming it on the environment. It’s like, well, we’re in emergency medicine. Yeah. We’re going to see what we’re going to see. And so I feel like that quote’s terrible because Yeah, it’s really good. I feel like it puts the control completely out of your abilities and Well,
Casey (01:09):
Yeah. And that’s what we wanna be in it’s control. Right. And that’s what we want to be. I mean, I see it, I see ems, I see our job as being an ameba. Ameba changes all the time. It adapts it. You know, put it in a square box, it’s going to be square, you put it in a round box, it’s going to be round. And I like going into different areas. I like going into the dark CD places that in the middle of the night where, you know, don’t know what’s going to happen. But I also, going into the emergency or into the nursing home and knowing that I’m going to see grandma or grandpa in there with a broken hip and I’m, I’m just going to be able to with take care of this. And
Aaron (02:00):
You can enjoy both types of
Casey (02:02):
Calls. Yeah, you can. And in fact, I’ve learned so much more from transferring patients. When I was flying, I had so much time to look over. Yeah. Doctor’s charts. I learned how to chart because yeah, I read them so much and I had nothing else to do on that long flight. Then don’t look at the patron’s records and go, okay, well it’s on. Yeah, it’s a ruptured belly button. I like, well I’ll get that. So I’ve learned more be because of that. But I’ve been able to glean, try to glean something from every call and I try to learn something from every call. And I think if you say that you’re burned out because of, you know, burn out because of certain calls or certain types of things that you,
Aaron (02:54):
That’s huge. I don’t want people to miss that because it’s the same thing in the er. Most of my patients I see are going to be simple. They’re not dying. They’re okay to go home. I have a little more work to do to prove they’re not dying sometimes than you have on the ambulance. But most of my patients are low acuity. And if you’re not choosing to take that as an opportunity to learn something, or even just with documentation, how am I justifying in the chart that this patient isn’t dying? Cuz there’s an art to that too. What are their risk factors and all this stuff? I think if you’re not learning something from every call, it’s going to burn you out. You’re like, ah, this is a waste of my skills. Yeah, I’m a paramedic. If I’m not innovating every patient, what am I doing here?
(03:36)
They can drive themselves to the er. But that perspective is huge to, I think, preventing burnout. Because if you can use every call as an opportunity regardless of the acuity, you’re getting something out of that. You’re learning something. Whether it’s looking through their paperwork and being like, ah, I never seen that medication before. I wonder what that does. Or reading their chart. I mean there’s something to be learned from every single patient. And I think if you’re not doing that, that will lean, that will lead to burnout because you’re thinking about all these high level skills that you can do. You’re not cardiovert a patient. You’re not intubating not giving these crazy medications that we have. And that’s huge. Yeah, I think that’s super, super good perspective.
Casey (04:17):
I see it as I had a new paramedic a few weeks ago was talking about a really great call that he ran and he was just on fire. He was just like, you could see the electricity floating off of him and he was just so high from it. And I said, weren’t you the guy that was burnt out last week? Because you’d taken the same patient drunk fighting being a jerk seven times in the last four days. I said, what you did when you did that? I said, you paid for this. Yeah. So you know, have to pay with some of those less desirable calls to get that really good one. And you only get that really good one maybe 10% of the time. Exactly. And so, you know, have to pay the piper and with running maybe 200 calls of, oh I fell down and it hurts. Okay, well can you get up? Yeah, I can get up. Do you wanna go to the hospital? Yeah, I probably should go to the hospital. In the back of your mind you’re going, you don’t need to go to the hospital. Then you get the drunk jerk guy that wants to spit at fight you and spit at you and threatened to kill you and your family and so on and so forth. You have to pay. Those are the things you pay for to get that really good call.
Aaron (05:50):
And none of us could run that really good call every time anyway. I mean I kind of consider that operating as your peak state as a paramedic. Right. Is using those skills that you’ve practiced so much and the stress level though. Yeah. But that’s why you felt the energy off of him, right? Yeah. Cuz it gives you energy, especially if you perform really well and those skills went really smooth on that particular call that gives you so much energy that will carry you for weeks of running the more benign calls. But I feel like you can only do that peak state, that super high level paramedicine so many times you can’t do that every call. No. Or you know, just can’t survive that way.
Casey (06:30):
It’s too much stress and thank God for emergency 9 1 1 in Chicago fire and all those things that that’s all they, yeah. So that’s the only thing they do.
Aaron (06:41):
But it’s not reality, but it’s not reality and it can’t be expected to be reality.
Casey (06:45):
Well when emergency nine one came out, they saved everybody. And I said that’s not reality. We saved 10% in a lucky year, we save 10%. So it’s just, I don’t know. But <laugh>
Aaron (07:05):
Good. I mean guess some of the last things I want to talk to you about are what advice, just in general do you have for new EMTs? New paramedics or that person that feels burned out, they want to be a paramedic for years, want, this is their career, this is what they trained for, they want to keep doing it. What advice do you have so that they can continue this and not feel burned out?
Casey (07:26):
Oh boy that’s the $20 question. And then it’s tough because, so what burns me out is not going to be what burns you out. So there’s no catchall remedy for that. I think you have to and I’ve found this out in just the last year or so. My knees are pretty bad. I’ve got some arthritis in my thumb and stuff, but cuz I’m getting old, I’m like 180 but I know I don’t look at it. But I think that you have to in this job, especially carry a healthier lifestyle than what we normally do, I think, don’t get me wrong and I don’t want ’em to stop doing it, but when we go into the emergency department here in Colorado Springs, doesn’t matter which er it is we’ve got chips, soda, this is water soda snacks, carbs out the ash. And we get those. And actually, you know, think about it, we actually have more of a sedentary job.
(08:49)
We’re sitting down, we’re riding around, we get out to take care, care of the patient, we put the patient in the back of the ambulance, we sit and we go to the hospital, we get in the hospital, we make our rounds talking to folk and then we sit and do our paperwork, we get back in the ambulance and we sit. So our, it’s kind of active but it’s an active inactivity kind of thing. And so I think eating healthier and, which is hard. It’s hard to do, you know get somebody like Dennis Wessling who, gosh, I mean look at him, he’s got 2% body fat, big jerk. But he eats like a horse. Mean he eats certain times a day. He makes sure that he at least has his snack and stuff. And so he’s like five meals a day, but
Aaron (09:40):
He’s not eating the chips
Casey (09:40):
From the
Aaron (09:41):
Hospital and the Pepsis
Casey (09:42):
And he will eat ice cream though I know he does that so he gets in trouble for that. But anyway healthy lifestyle I think is one of the things that leads to better psyche for sure. Cuz you’re not worrying about your weight or stuff. And I’ve lost a ton of weight in the last year that, and I feel so much better. And I think I do my job better. I think my family life is better. I know
Aaron (10:10):
My less prone probably to a back injury.
Casey (10:14):
I try to get in the gym at least three days a week. I’m busy. I’ve got kids and they keep you busy and coming and going and thank God Tyler can drive now cuz he can help out. But
Aaron (10:26):
You gotta take care of yourself. You do. I mean I think that’s key. I think how you eat really matters. If you’re getting enough sleep that matters and that’s all. This is hard to do. This is something we’re not saying we’re perfect at all. It’s something you gotta work at. And I think that’s
Casey (10:42):
Important. And I think we tend to, it’s hard to say and hard to do, but I think we tend to bring our jobs home. We tend to bring our home to the job and it’s hard to keep those separate sometimes. And sometimes they both suffer. I think that’s one of the issues. Staying away from mind altering substances or alcohol as a crutch. No, I’m not saying don’t drink everybody. I like to have a little shot of whiskey once in a while too. But I don’t do it to confess and I don’t do it every night. And if you are, then maybe you need help.
(11:32)
I think one of the other things too that I would tell somebody new is listen if somebody tells you or suggests, you know, may need to talk to somebody or hey is somebody, is something going on with you that we could discuss? Listen. Because not only do we become friends and workmates, we actually become family in this job. It’s so stressful. Not necessarily because of the call, but because of just everything impacting and compounding on us. Sometimes it seems like the people that we work with are more family than our family. So I try to listen when somebody comes to me and says, are you okay? And it makes me reflect and go, well maybe I’m not okay, maybe I need talk to you Rob WildHorse and I have that kind of relationship and Curtis Roberts and does too. So I think listening to our peers that helps.
(12:44)
And I would say if somebody says something, listen, I think that you need outlets physical outlets, mental outlets. Gosh, I’m in the middle of a book, what is it? Oh it’s about the glomerulus. Oh come on. Really? What is it? A novel. It’s not a novel. Come on, read something, read a spy novel. Read historical fiction or whatever. But get away from medicine per se, and distract in another completely different direction. Find a hobby. Woodworking is great. It doesn’t take a whole lot up here. It does, but it doesn’t. And it’s just a completely different box that you have to think stuff and it gets you away from remembering what acid based balance is and that kind of thing. I said I think so that’s one of the things try to find something else to do when you’re off or even when you’re on work. Gosh, making bracelets or something, whatever. Leland Haldeman’s a great example. Steve Berry is a great example. Mm-hmm Artists Leland’s great. Steve is funny, funny, funny man. And his cartoons are so on point, even though they’re about us, but it’s still a distraction for him and stuff. Don’t lose your sense of humor and if you don’t have us into humor, find one. Yeah. Because you gotta have one in this job.
(14:35)
I cleared base the other day and we’ve got shift codes now, and I said, our shift code isn’t here in here for the first to put in the communications part of the job. And the dispatcher said, well it’s not built yet what time are you off? And I said, well what time is it now? And she didn’t think it was funny at all and I paid for it by going on a out of town transfer, but I thought it was hilarious. But you need to find a sense of humor and maintain a sense of humor and you know, could tell me right now who the funniest people in this job are. And I’d probably agree with you, and they’ve been around too for a while. Eddie Baker, Terry Zog, they’re funny people, but they’ve, how they work through some of their hard times. And I think those are some of the things. And just do the job the best you can do and just realize that it’s not always the best that somebody else can do. But you need to do the job the best that you can do and just strive to strive for, but to perfection. But know that you’re never going to ever get it right. You’re not going to make it. It’s like it’s playing golf.
Aaron (16:06):
Yeah.
Casey (16:07):
So
Aaron (16:09):
Yeah, I think all of that’s really good advice. And just the awareness of when you are getting burned out, which one of these things are you not being very good at? Yeah. Are you not having a sense of humor about your job? Are you not getting enough sleep at night? How are you eating? How much are you drinking? I think cuz none of us are perfect at it, but I think the more of those elements you can incorporate, the less burned you’re going to be. Because like you said, there’s no one strategy to prevent burnout. No. Even in that article I was reading, it’s like all their advice is it’s not super helpful, but it’s because there’s no easy solution
Casey (16:45):
To it. It’s so complex. Yeah. I, and it won’t be popular with a lot of people, but I think that you have to have some spiritual awareness and realize that we’re not in charge of what we do. I’ve seen it so many times. And case in point I was in Winter Park with a bunch of our peers and we were riding bikes and man, it was just beautiful out there. And I looked up at him, went, man, God is great. And one of ’em said, you believe in God? And I said, absolutely. And he goes, how can you with all this stuff that we see? And I said, how can you not with all the stuff that we see? Yeah, absolutely. How many times have we gone on calls where we did everything? The patient was young, the patient was healthy, we got the tube, we got the line, we got the drugs, we got the electricity, we did everything. It happened right in front of us and they end up dying. And then we go on the next call and it’s old decrepit grandpa who’s been smoking for 86 years, three packs a day and we can’t get the tube, we can’t get the line, we can’t do anything. And they walk out of the damn hospital two days later. How is that? It’s not in our hands. It cannot be in our hands.
Aaron (18:26):
Thanks a lot for your time, Casey. I think that if people watch this and especially watch it a couple of times, I think it’ll really give them a lot of really good perspective. If people are feeling burned out, I’ll put Casey’s email my email down so you can reach us. We’d be more than happy to email you back, talk to you on the phone, meet with ya. Sure. If you really are feeling burned out, we want to help you with that. I think Casey’s found great ways to not be burned out myself. I feel like I’ve figured out how to do this job for a long time without feeling burned out even in the er. So please reach out to us if you feel so inclined. If you feel like this video is valuable, please comment. We’re curious what you guys liked, what you didn’t like. Subscribe to the channel like it, that will all help me continue to be able to do this. And just remember that there are very few careers and jobs where you have the opportunity to save a life. And while that opportunity, opportunity doesn’t come every day, it is around the corner. So you always gotta be ready to take that opportunity. So go out there and be the best providers that you guys can be.
